WHEN A PATIENT SAYS THEIR PAIN IS A 10/10...BUT YOU KNOW IT'S NOT!
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- čas přidán 7. 07. 2017
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What these negative commenters are forgetting is that pain is not just assessed on a scale by a nurse. You look at their physiological symptoms, high HR, sweating etc. Someone falling asleep is not experiencing 10/10 pain!! This is coming from a student nurse that has has experienced chronic pain for 15 years.
This is very helpful as a nursing student. You explained it in a way that would be respectful to the patient but also standing your ground in maintaining their safety. I find myself being kind of an agreeable person, but it's nice to know that there are many ways to be respectful and kind while still saying no to a patient.
As a patient who’s had chronic pain going back to him a very bad back injury over more than a decade to me this is a very slippery slope. Unfortunately there are those out there who abuse the situation and cause people that actually do have pain trouble in that and this is my experience that doctors surgeons nurses that work in medical professions where they’re dealing with a lot of pain management people seem to have this overly questionable attitude. Especially if you’re a new patient you are met with uncomfortable suspicion. Also in my case where I was under doctors care for more than a decade and then moved to a new area where I had to find new doctors who knew nothing of my medical history even though records were requested the records they got were slim to none so they have no clue of your medical history they have no clue of the severity other than what you tell them so again you’re thrown into the new patient category where they’re very suspicious about everything. Now I understand the dilemma here but to be honest no different than a person on the street or a family member if you find yourself in a position of questioning whether someone’s pain is real or not unfortunately I don’t see how you as a medical professional can possibly have any clue of whether that person‘s pain is real to them or not. No you can compare that person to other people and I’m sure there is some sort of baseline but one of the worst things about being a disabled person or being in pain is that there’s this weird psychology from other people. They just don’t want to believe you. I’ve been doubted by my close family members even a wife brothers friends doubted by everyone even though I was in excruciating pain. So as someone who deals with a tremendous amount of pain on a daily basis I would find it hard to support any medical professional that thinks they know what level of pain that particular individual is feeling. If that woman said she was 10/10 on pain then to her she is 10/10 on pain meaning that’s the most pain she’s ever felt in her life. Some people that can be very little pain I suppose compared to my 10/10 which was laying in a hospital bed in complete shock all limbs frozen body frozen like being electrocuted. To me that’s 10/10. To another person breaking their finger may be a 10/10. To another person getting a deep wound on their hand may be a 10/10 10/10 simply means that’s the worst pain that persons ever felt no matter what level of pain a person feels when it’s the most pain they’ve ever felt then that’s what it is. See pain doesn’t ride on a scale that matches everyone. It’s like running when you first start out running you run a mile you think you’re gonna die your bodies hurting worse than you’ve ever felt and you keep doing it eventually run into miles and then you feel like that at 2 miles and then three you’re hurt you keep on Goin 4564 you know what you’re running a marathon at 1 mile is nothing. That’s how pain works to the person that’s never run a mile that’s the worst pain I’ve ever felt. To the marathon runner that 1 mile doesn’t feel like anything but the 26 miles does. Pain is based on the individual it’s not a grand scale of levels. Anyway that’s what I have to say about that.
Helping a pt understand the pain scale is a major factor. I find pt use the 1/10 scale compared to the pain they have ever felt, not the pain imaginable. As I deal with military I can be a little more graphic with them, however, my scenario tends to be effective most of the time ..."A 10 is a bear just bit part of your face and you passed out...are you sure your pain is a 10?" They also find humor in it so its a win-win!
I am a respiratory therapist but I completely agree with this video!!! Keep doing your thing girl 🏩💕💘
To clarify to those who are getting upset....
If a patient is saying their pain is a 10/10....and they are not showing obvious signs of contraindications to giving pain medications...low BP, not arousable, falling asleep within seconds after leaving the room, or other OD signs...of course you will treat their pain. If I have pain meds ordered and the patient is appropriate for me to give them pain medications, then of course I will treat their pain...whether "I believe" it is a 10/10 or not. I'm a huge supporter and believer of pain medication....when used appropriately. As nurse's we are responsible for appropriately giving pain medications and advocating for our patients. But when it comes down to it...our number one priority is keeping patients safe....and if treating their pain compromises their safety....then you have to find the safest method for treating it.
This video was geared towards those types of patients who constantly request pain medications but clearly are NOT appropriate to receive them (I.E..report their pain a 10/10 but are not arousable to tactile stimuli). As nurse's, we are taught to always treat pain...but there are times where it is not appropriate to treat pain...and it can be difficult to explain this to a patient when you are a new nurse.
I apologize to anyone getting offended. If you have watched me long enough, you know that that is never my intention.
Ashley, I think a lot of people also don't take into consideration is your license. People need to understand your license is your life! Going to work everyday as a medical professional means you are responsible for the patients you are treating. If a patient as you mentioned is over medicated and you don't do a proper health assessment and you give them the medication and they OD or die, then whose license is at risk? YOURS! You then have to tell the State Board of Nursing why you gave the medication and can lose your license for negligence. You need to be able to hold medications and call your doctor and tell them, "hey this patient is snowed out of their mind can we give it later?" OR You can tell your patients, such as psych, if you can't sleep or are having issues we'll reassess in an hour or so.
Also, if you are currently in nursing school and or are a nurse you should already know that any patient we will ever see we should see in an unbiased fashion. I believe Ashley upholds that to the highest extent when she first meets a patient. But you need to understand that a health assessment which is the first thing a nurse does to a new admit is IMPORTANT. A lot of what Ashley speaks of in the video can be found in a health assessment and reading through notes. If you are with a patient some actively tell you that you can only use a certain vein because the rest are not going to stick, and you can see veins that are just absolutely destroyed. Does it mean judge them, no, but it should bring a bit of caution when a patient is repeatedly asking for pain medication and does not take into consideration your active patient education.
Treating pain is hard, because it is subjective. You have to respect pain and attempt to treat it but if you are unsure it isn't worth losing your license over. When looking at objectivity and subjectivity, and the medical notes, some if not most times you can tell when patients have pain because it correlates one another. When assessing pain there are also symptoms as well many become unfocused, sweat, inability to sleep, adapting certain body movements in order to function without pain (basic example: limping), depression, suppressed immune response, etc.
In this day and age with the opiod epidemic, it is unfortunate that medical professionals have to question their patients at times. However, you have to remember as a medical professional giving medications and not taking into consideration the patient you are working with can cause you trouble.
Maybe it's time for an ethical video Ashley so people have to understand the issues that are going on in nursing today.
Cyrus Zandi Some folks are just geared towards being "super nurse's" that they don't realise how much weight their license really hold. As hard as it is to receive a nursing license it can be snatched away and just like that you're searching for a new career. I wholeheartedly agreed with Ashley and understood where she was coming from....
Depends. The va for example. You tell them you have a 6 or less and they tell you to go home. My foot, back and knee are trashed and they here about an 5 all the time and 8 or 9 when on bad days. If I fail to tell them it's a 7 all the time and a 10 on bad days. I don't get treated. Had I received an mri, surgery proper medication 6 months ago it's likely I would have avoided being disabled for the rest of my life. On one hand you have concerns for your license and pill popping addicts. On the other didn't you go thru all that school, studying, certifications, etc to help people? If helping sick people is what you want or do, help them. If guarding a license and making money is your goal become a licensed contractor, you will work less hours, make more money and hardly ever deal with sick people.
That was some great approach/advice to diplomatically refusing pain medication to patients, based on subjective/objective observation. I would have never thought of approaching it like that. Thanks!
It's very hard to walk that fine line. I am a healthcare worker, who lives with daily pain, and a J tube. I take 25 mcg/hr Fentanyl, and have break thru pain most days, because I am active. I take Tylenol and ibuprofen for the additional pain, but, some days this isn't adequate. On those occasions, I have my Oxycodone HCL10mg tablet q6h as needed. It's horrible to be in constant pain, and I pray daily, that I could go without anything but the Tylenol. I am NOT a drug seeker, and try not to take additional doses of my narcotic meds. But, some days, once home, I gladly take my 10mg Oxycodone (5mg ) is what I usually take, if it doesn't help, then I take the full 10mg dose.
I thought this video was great, such spot on. I think the people who are getting antsy about it just haven't experienced the situation where you have a drug seeking individual who is so close to receiving narcan, barely breathing, barely awake, yet still stating a 10/10 pain. That was a moment that happened when I was a student and I remember being stunned at what to do because of what were taught in nursing school, but at the end of the day you're completely right. Their safety is what is most important and we need to rely on our nursing judgement.
Samantha Long you took the words out of my mouth! Thanks for your insight. ❤️
Samantha Long I agree ! I had a patient last semester who said his pain was 10/10 but was dosing off from his previous morphine IV push...I think it varies from person to person. I agree with Ashley that safety comes first!
Thanks for all you do Ashley, it's appreciated. I wasn't upset by your comments in this vlog. But, it is hard, and we should always advocate for our patients in their best interest.
some patients are in pain all the time and don't show it. saying stuff like this makes it harder for people who don't "seem" to be in pain have a much harder time getting treated. its super common for people to not believe me, because it doesn't "seem" bad. believe your patients. you don't know what they are feeling. not treating them is also not safe.
Great Point! #1 Priority is keeping the patient safe.
I work in PACU and I have had my fair share of experiences with patients reporting a high pain score but would otherwise look okay as supported by their vitals. We use FLACC scale to support our pain assessments. I'm not one to withold on pain medication if patient IS in pain especially post op but I have discharged patients who says their pain is 9/10 but their vitals and their body language say otherwise. I always document my assessments and handover this info with the ward nurses, something like "So patient reports a 9 and this is what a 9 looks like (Pt sleeping, no crying or grimacing, vitals good, responsive and cooperative, etc) and these are the pain meds I have given..."
Keep in mind that while, yes, we are taught that pain is what the patient says it is, and that we are obligated to treat pain, that that does not mean we have to treat with narcotics or any medication for that matter in certain situations.
Many times treating with heat or cold packs is sufficient. Massage, stretches, rest, body positioning, Lidocaine gel/patch, Biofreeze, anti-spasmotics, muscle relaxers etc...
I can't tell you how many times I received an admit in post acute rehab with orders for opiates, but NO acetaminophen or ibuprofen orders. (We had no standing orders.) Physical Rehab patients is one of the biggest populations of patients at risk for opiate abuse and then addiction.
Before pain gets out of control, try an alternative to an opiate first. It may keep the pain from escalating and keep the pain manageable. Many patients are under the illusion that our pain management plan MUST treat their pain to where it's a 0.
If a patient states their pain is a 6 and starting to get too uncomfortable, and if we jump right to Norco or Oxycodone, we are contributing to the Opioid Epidemic. We are putting them at risk for tolerance and addiction. So....Pain at a 6? Try tylenol/advil/naproxen with previously stated measures 1st. If it drops to a 3 and is bearable, then I consider that success.
ALSO, and this is big, educate patients on WHY we ask for a pain scale rating. I am asking what their pain is beforehand so that when I treat the pain I can go back and re-evaluate their pain level to see if our pain intervention was successful and appropriate. I'm not asking to judge. I'm asking so I can assess the effectiveness of my pain intervention for the best outcome. Sometimes the best outcome is a pain decreasing to a 3 with tylenol and heat and massage, rather than down to a 0 with Norco.
It’s so unfortunate that certain types of people have drug seeking behavior and make it difficult for those who actually have chronic pain to be believed or questioned like that. It’s also sad that certain groups of people have been treated as if they have a higher pain tolerance and they get ignored by ignorant medical staff. Seen it happen for over 2 decades and have definitely been a whistleblower in several cases.
I totally agree with trying to keep the patient safe, especially when giving PRN pain meds. And besides, they can end up maxing out their ordered doses of pain meds. Back in my medsurg rotation, I had a patient who had a lot of pain due to a underlying chronic condition. we would try to maximize the reduction of her pain in between and during her pain meds with nonpharm interventions like heating and cooling pads, music, chatting with her family, tv, etc. When she ended up maxing out what could be given within ordered timeframes, the patient was educated on safety concerns. But she insisted that her pain really was 10/10 and we believed her. We then told her that if the pain medications were really was not meeting her 10/10, she needed to speak with her physician.
Thank you for sharing. This is very useful information and wisdom to know.
I wonder if you're able to look up and see how many times a patient has been to a hospital in a month. And to check if they keep coming back and getting pain medications. That could really solve the puzzle. Anyways, very helpful video thanks
Great video and very informative! Also, you do NOT at all come off as a stuck up ass hole. People get carried away with themselves when they're hiding behind a computer screen.
Shelly Williams thank you! Wasn't intending to come off as one! Just trying to educate others on a difficult topic.
Ashley Adkins, RN Of course! keep on with the videos because we love em!
We use RASS scores in our charting to back us up in our pain interventions. Especially for an instance like what you described and of course a note if needed.
Olivia Taylor RASS is a great way to back up your charting. I use that a lot as well, along with the neuro assessment charting.
I’ve been on pain meds 10 years under dr supervision. I had a quadruple bypass and the nurse on duty cut my pain meds from 10 mg at bed to 2 mg stating I was fatigued. I just had bypass. So in an hr or two I started withdrawals. The nurse was rude it was hell. The next day my surgeon was so angry. I was so close to pulling out my pic line Iv chest tube all of it. Just saying find out entire history. She coulda killed me
yes I totally aggree
I just realized we have such similar headboards!
YUP! I made ours a few months ago! :) I love it!
You're better than me! I just paid someone to do it! Haha!
You guys made your last one though, right?!
Yes! This time I wanted the whole bed instead of just the headboard so I had someone do it!
I feel like everyones "10" on the pain scale is different
=/ this is going to be tough to play out when I become a nurse....
As long as person doesnt have underlying condition that causes pain..I have a friend with sickle cell disease and its a struggle in the er at times...
My kids have SSD I worry how they might be treated as they get older in the hospital.
hadgit60 As a nursing student who has SCD I can tell you adult hospital for us is terrible. Your labeled as a drug addict, your pain isn't believed, it's hard to get help or adequate care. I am fortunate to have a great specialty tam but he ER is a while other beast.
hadgit60 SSD is a painful disease....that warrants pain medication. Chronic pain and acute pain have many differences, and should be treated appropriately.
Ashley Adkins, RN ..Just having a discussion..I see what you mean from your standpoint was just throwing in a different side. Im sure there are drug seekers, but some people that have SSD are thrown in with that population.I love your videos and content.
Nelva Blackmon ..Its really sad how peope with SS are treated..It's vital to have a doctor and team that advocate for you. My kids are 6 and 1 so still long time off from transitioning to adult hemo. It's amazing that you havent had a crisis in so long. Im just finishing up my first semeter in nursing school. My maiden name is Blackmon I wonder if their is any relation.
hadgit60 awesome! Lol maybe. I've actually been working on my family tree. We have roots in Texas Louisiana and Virginia a as far as I can tell all the way back to 1840's.
Also if we are on these meds daily on a schedule it keeps us ok sometimes until the next dose. Duh. I mean dropping the Amnt she did after I have been on it so long endangered not just me from being on it to keep me in control but my heart suffered from the bypass and sudden surge of withdrawal.
I’m not a fan of the “pain scale” when I was in the hospital with colitis they asked me this and said “with a 10 being the worst pain you’ve ever felt in your life” which at that time it was, so I had to say 10. But at the same time I’m sure getting shot hurts waaaay worse and I felt weird saying it was a 10, because I was just vomiting. 🤷🏼♀️
I just feel like it’s a really non objective thing lol. Can’t wait to deal with it in nursing school!! Lol
I thought pain was objective? If the patient is "saying" that they are having pain in a certain area we as nurses have to be there advocate and maybe ask the Md if we can order certain labs or get an Xray, MRI, CT scan, ect. to find out the exact origin of the pain...I as a nurse would try to exhaust all my options as to why this pain is not being alleviated with prescribed medication, maybe even suggest that the resident should go to a pain clinic. Safety is first, but I would hate to leave someone stating they are in pain without exhausting the options.
Im sorry.. pain is SUBJECTIVE..
I agree that pain is subjective, but in my opinion the 10-point pain scale is not always a good measure. I've had clients report a pain of 8/10 but they were smiling and moving about... which indicates to me that it's more of a misinterpretation of the pain scale. I agree though, that when a patient reports a high pain, it warrants further investigation rather than immediately proceeding to intervention.
Nicol Bolas So with that being said, how would you rate someones pain without using the 1-10 scale? Just curious..
Gracious Diva we absolutely are there to advocate for our patients! If pain is being unmanaged...we should take a step back and look at things. Are we giving the appropriate types of meds? Dose? Frequency? Or is there something else going on socially, emotionally, physically, etc.
We absolutely need to treat patients pain, unless it is contraindicated due to safety reasons. That is more of what this video is geared towards.
I will still use the 1-10 scale, but I would also take into account the patient's understanding of the scale. If they say they are a 10/10 on the scale but obviously do not look that way, I would clarify with them what the scale means, perhaps give a few examples of the level of pain that they can associate with.
Hi Ashley and other nurses,
I am still a student and have a question:
Is it within the role of a nurse to suggest to a doctor treating a patient for withdrawal from opioids? For example to get them on a limited efficacy opioid such as buprenorphine to lessen the withdrawal but slowly taper the dose? Is this level of care not always possible in the hospital setting?
I'm asking as a pharmacology major. I've had lectures about these types of issues, and am likely going to start a nursing program this year and am curious if you have a legitimate suggestion you can make it?
Thanks for your videos :)
I'm extra curious because I live in Vancouver where there is a fairly serious opioid crisis and one of the downtown hospitals has many opioid-addicted individuals as the hospital population at any given point.
I am starting college for the first time in August. I want to be a nurse so bad so that is what I am trying to go for.
the only time I said I was a 10/10 was when I was in labor with pitocin for 2 days back labor. my epidural didn't work and literally the pain was the worst. like my body was pushing and the nurse kept telling me to stop. it was impossible to try to stop something I had no control of. I was begging for a csection for 8 hours. my baby's heart rate dropped from 145 to 32.
thankfully all is well. There's not much pain med options when you're in labor though. Or at least they didn't work on me.
The nurses were amazing and I made sure to tell them they were. Just not a fan of pitocin for me.
What a relief to know that you as a nurse would take a grander approach to a patients pain. By you having such a big platform on CZcams and reaching probably millions of people that are perhaps in the medical field, should choose your words carefully. Someone might take your advice and run with it, not taking into account all of the different options that we can tackle before just saying "well your not due for a pain med at this time" ..meanwhile there suffering in agony, which is barbaric in my opinion..but thanks for the clarification.. thanks for the content.
As a nurse AND a person with chronic pain/illness I will never use 10/10 unless necessary for my pain. I always say if it’s 10/10 it makes you feel like you can not handle anything anymore. You can physically see a 10/10. Sweating, shock, paleness, nausea and vomiting, crying, fainting etc. That’s 10/10. If you can sleep, I’m sorry that’s not 10/10. 9/10 8/10 yeah I could see that, I sleep to getaway from my pain as well. What you said was great! And I completely agree pain is subjective. I’ve had my pain for 7 years now and and when I first started to have my pain it was bad like 8/10 but as the years have gone on my pain tolerance is higher and what used to be 8/10 is still an 8/10 but I make it look like a 4/10. So I see both sides but I agree with you here, if there are clear signs of addiction and substance abuse you can not as a nurse put that person in more danger by giving in to what they want not what they need.
I HAVE had 10/10 pain. I now joke that it was 11/10. I had rotator cuff surgery and came out of the surgery without the nerve block working and they offered me an OxyCodone pill and my husband and I tore out of that hospital knowing they were going to grossly underestimate my pain. Fast forward 15 hours later---the meds I had at home were not doing the job. We had a bottle of HydroMorphine from a family member that had passed from cancer as a back-up in our first aid kit. I took the Hydro according the the directions on the bottle, one every 4 to 6 hours. By the morning I had to call the nurse at exactly 8:30am as I was in full-blown shock, shivering, dizziness, sweating, and crying over the phone. The nurse sent in a matching prescription to our local pharmacy and in the end it took my at least a week to get "ahead" of the pain. The nurse doubled the dose of the Hydromorphone, and it was a godsend. They slowly tapered the dosage down and switch to Tramadol, the common course for pain management in case of something so intensely painful as shoulder surgery. A 10/10 pain scale puts you into SHOCK. I just had two surgeries where I reported an 8/10 (full face lift with painful brow lift) and a laser lead extraction with a large scar around my heart (7/10) when I woke up. Both nurses offered me Tylenol as first. REALLY??????? The facelift surgeon finally gave me intravenous Morphine which I could NOT tolerate and I threw it up all night. I am a clear example of someone who is not a junkie, who cannot deal with intravenous opioids, and is very sensitive to pain. So the operation I had last Thursday (7 days ago), I can't get them to order me a prescription for the pain that works, so I've resorted to taking sleeping meds around the clock and stay in bed knowing that I'll crawl out of bed when the pain is tolerable. Quetiapine makes you sleep whether you like it or not---that's good for the evenings, and Diazepam makes me drowsy during the day so I stay in bed. Not a plan that is conducive to healing. Look, they take blood samples from you before the surgery--can't they tell who is playing the system and who already has NO pain meds in their system? Lastly, who on god's green earth would go to a hospital for 3 ablations, 5 pacemaker surgeries, two hand surgeries (!) and a removal of an ovarian cyst just to get meds. Most of these surgeries HURT.
I’m a nurse as well, so I say this with the same kind of background, but… who are you to question what is and what is not painful to someone? Pain is completely subjective - what is torture for someone else may be nothing but an ache for you.
You’re talking about two different subjects here: one is signs of drug seeking (and even then I will always believe the person when they tell me they’re in pain, and will liaise with the doctor to see how much pain relief we can give the patient to ensure that they are comfortable as possible)
I have chronic pain. I am usually in severe pain. And to be treated in ED by nurses and doctors who think I am making my pain up (I’ve never said it’s 10/10 but I’ve definitely been up to a 9/10), and I’ve had a nurse just WALK OUT OF MY ROOM when I was literally crying and writhing in pain. I didn’t see her again for the entire shift. She didn’t even hand it over to anyone.
It’s such an awful experience. I would NEVER just tell any of my patients “clearly your pain is not a ten of out ten”, or “sorry, I know you’re sobbing and screaming, but we have reached your pain killer limit so you’re gonna have to deal with it please don’t bother pressing the call bell for pain relief because you’re not getting any”?! No, I would ring whatever doctor governing that patients care and I would make DAMN well sure that if we couldn’t completely get rid of the patients pain , I would certainly ensure that my patient would become more comfortable before I went home.
Also, as a person with chronic pain, and therefore on a high amount of narcotics, obviously my tolerance for those narcotics is a lot highly than someone who is opioid naive. So some nurse coming along with no idea of my history and who patronisingly tries to “educate” me about what is and what isn’t a safe dose for me would be highly offensive, and upsetting.
(Also, you mentioning highly problematic statements like “you can always blame it on the doctor as to why you cant give them pain meds”, “yeah we have to chart that their pain is said to be 10/10 when we know it’s not REALLY 10/10” is somewhat concerning. Your job isn’t to decide who is and who is not a drug seeker - it CERTAINLY shouldn’t be your utmost priority when you have a patient stating to you that they are in a distressing amount of pain? No human being is a lie detector. How on earth can you *really know* what another human is feeling inside their body?
Again, when you have patients who more on the chronic disease kind of end of the scale, I guarantee you from personal experience that if I were to react constantly to my pain, all I would be doing is writhing around unable to talk and crying and sobbing and I just don’t have the energy to be like that 24 hours a day but that doesn’t mean I am not in pain? Some patients are better at hiding it than others. Again - it’s not your job to play detective and figure out who the liars are. A nurses first priority is being an advocate for their patient. So then if I call the doctor (who sees my patient for 1/100th of the time I do) flat out refuse to do anything for my patients pain relief, instead of using that as an excuse I can pull out of my pocket if the patient keeps complaining about their inadequate pain relief l, I am going to question and question and question that doctor for a) an alternative to whatever pain medication they’re refusing to give and b) some bloody good rationale as to what is making it so unsafe that they are refusing PAIN RELIEF.
And it’s interesting that you bring up the pain scale and pain relief being one of the first things we are taught in nursing school; that’s because maintaining adequate pain relief is one of the most CRUCIAL aspects of care?! Once you can get on top of the pain, then a lot of the others problems can be dealt with more efficiently (some may be completely solved I.e. a more stable HR, resp rate, less anxiety therefore better able to rest and sleep)
A video like this is such a dangerous philosophy to be spouting especially since so many health professionals nowadays seemingly have forgotten that patients can actually have LEGITIMATE pain that needs relief and that not every patient who comes into hospital is a drug-seeking liar (I’ve been made to feel this way and it’s absolutely awful; I would literally try to hide any expressions of pain from certain staff due to experiencing sniggers and rolling eyes from them… hospitals are a huge source of trauma to me because of this)
Drug seeking or not, it’s not your job to lie detect, it’s your job to be nurse.
They have a low pain tolerance not high if they overestimate their pain score.
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Was something i needed to hear! Thank you so freaking much!
saying drug seeker because you don't believe a person's pain.... is despicable. I have been called drug seeking more times than I can count. when I have never exaggerated my pain. but everybody assumes
What you said about the patient who was taking 500mg a day on the street. Were you assuming that they were just looking for more morphine? Because I understood that as "I have a high tolerance to morphine and I don't think that's going to work" The problem then arises that their pain isn't being controlled and they ask for more pain medicine and you label them as a drug seeker.
I applaud anyone who owns up to their past demons and will flat out tell you what they were taking on the street. That doesn't mean that's what they're asking for. But past narcotic use needs to be taken into account when treating pain.
SuziiLanette I agree with you. It takes a lot of courage to admit that you do use drugs on the street. It is important to treat pain when no contraindications arise. Typically for those who have a high tolerance to pain and come in seeking high doses of pain medication...we will add some sort of benzo into the mixture to help with the withdrawal/craving symptoms. No physician is going to order enough pain medication to equal the 500mg of morphine someone was taking on the streets. They will order a safe dose of pain medication and some sort of withdrawal protocol to safely help the patient withdrawal. And sometimes they won't order any pain medications depending on what the patient came in for....I.E. drug OD.
Now I'm just getting off on a tangent...:) long story short...it all comes down to an appropriate nursing assessment and keeping patients safe. :)
Hi there!
I have a quick question and wanted to know how many days do you work per week? Do you work 3 12's?
Great video! thanks for the info. I actually have had pts that say they're in 10/10 and you can observe otherwise. Very important the last part of the video about MDs backing you up. This has happened to me a lot lately when I have a pt asking for a stronger opioid and the Dr. refuses to order something else because of the pt's behavior.
I have grown up very sick with many chronic illnesses. I am no stranger to the hospital. When the doctors do rounds, they assess the patient and based on that evaluation typically they will make changes to their medications or decide to keep them. As a nurse, if you witness your patient acting suspicious it is VERY toxic to talk to the patient about it. Although, I totally encourage you bringing it up to their doctor. As somebody with GI issues, my doctor and I communicate very closely and I know how dangerous narcotics are not only because I can become dependent on them, but because they can upset the stomach. I am very open with my doctor. Recently I was in the hospital for a skin infection all over my skin and it happened to be located on my stomach. My nurse was very busy and knew me from previous admissions so she assumed my skin infection on my stomach was the same stomach issue I typically was admitted for. This infection was so painful I could not sit up straight. My doctor and I formulated a plan to use the very lowest dosage of dilauded. Since my doctor had years of trust built with me, he knew I would tell him if I felt dependent and we would switch to something less aggressive. My nurse was very intrusive when it came time for my pain medication, and it unfortunately got to the point where I had to tell the nurse that as long as my orders are in the computer she can either contact my doctor and delay giving me the medication until he gives her the okay or she can give me the medication. My doctor was very happy with how I handled the situation. Please just mind your business while in the room with the patient, but by all means communicate with the doctor if you think the doctor should adjust the medications the patients needs. Thanks.
This has always been a huge struggle for me, working in pediatrics. We get a lot of teenage girls with intractable headaches and they say they're always 10/10. They max out what we're safely allowed to give and the PARENTS get upset. Thank you for sharing your experiences!
The ones ain't drug seekers you assume they are win a patient ask for pain meds to been done to ppl goes to Ers to. I know a lot ppl ain't er Dr think they are just cuzs ask pain med to. Not everybody drug addict it ask.
This is true, working in LTC I had an alert and oriented pt who was there for rehab, and iv abx , every night she asked for her oxy. One night I finally asked her nicely, why exactly do you want your pain meds every night? She told me it was to help her get to sleep. So I explained to her that wasn’t the intended use of oxy and we can get her some medicine ordered for that purpose. She was totally agreeable. So I think another consideration is why they are actually asking for it, maybe they need an antidepressant or anxiety med or sleeping med instead. I’ve never worked in a hospital but my hubby has and I understand this difficult line. But I totally agree with keeping safety in mind. I was even taught in school that if their respers are low you should hold it.
Woah woah how can you judge if it's a ten? Have you had a chronic pain condition? People have a pain tolerance that is higher than most people. I have sickle cell disease and while at the moment I'm not taking any narcotics because I've been blessed to not have any crisis in the last two years, there have been times in my life where I have been on morphine or had to go to the ER to get dilaudid. I didn't cry or moan with a 9 but if I am crying that means it's unbearable. I totally understand keeping things safe and keeping medicines time but don't assume because of what you see. Even if they are addicts there pain is a ten out of ten to them but yes as a nurse you can't give them meds that will essentially give them an overdose. However, I hope you realize that this continues the stigma of chronic pain for those not abusing drugs.
You have to take in to consideration a lot of things, Is this the first or 99th time in a month that the patient has been in the hospital with? Drug addictions to pain medications are a REAL thing. There is a lot of warning signs people can watch out for. She is by no way saying to ignore them or improperly judge them.
Nelva Blackmon I completely agree with you, I also suffer from sickle and just happen to have a higher tolerance for pain but when my pain is a 10, regardless of whether I'm showing signs or not, it's a 10! I also have been overdosed which caused me to go into respiratory arrest so I also understand the importance of safely administering medication but there is a stigma and phrasing is important.
I was thinking the exact same thing. Especially for people that have been living with their pain their whole life. The pain tolerance of their body would be a lot higher than normal
bullshit, a 10 is to the point where you are going to pass out
Idk how I came across this video..but I watched it assuming I'd know what they really thought about us. #sicklecellwarriors and other real things.. I get that she's not implying anything about us really....so I'm only commenting to say you r not alone to my fellow scd warriors...as I rype this my pain is a 8 n going up fast I will not b going to the er
Blame the doctor 😉
I hate these type nursess🥶☹️
You sound like a good Nurse. 🌞
you have NO IDEA what their pain level is since you are not in thier body, its abuse and neglect to not give someone enough pain medication. and you cannot deny someone pain medication becouse 1 out of 100 patients are trying to "get high" or abuse pain medication. you need to rethink this and perhaps rethink being a nurse becouse when you begin to look at patients as a "pain in the neck" you are in the wrong profession.
That's not what she's saying at all. Safety is a priority over comfort and it's apart of the Maslow's hierarchy of needs in the profession. Risking a fall or an overdose can compromise them and it's best to be safe and hold off until they're more aroused.
True I'm an INFJ and we just know there are a few that is drug seeking but we have a list of drug seeker and abuser
They don't care about vital signs dropping, pain med addiction is an epidemic. When someone says they have a 10/10, yet they are laughing and walking in their room, it makes me all the more determined to refuse to accept pain meds for myself. I once had a kidney infection from not drinking water (it was my own fault) I was given Tylenol #3, and after only one dose, it made me so out of sorts, I flushed the rest of the bottle down the toilet, and never saw that Dr ever again! (I didn't think of how it may contaminate the water at the time, I just wanted that garbage gone) I figured since I survived childbirth without epidural, I didn't need his addictive meds. Some may truly need the pain meds TEMPORARILY, but I lost 2 friends who took meds long term, and had back issues, and it destroyed their kidneys.
Pain is only objective. One thing I was taught is to do right and not good. Although knowing the patient pain isn't a 10 it is still the duty of the nurse to give the meds. Providing comfort to the patient is the right thing to do. I believe it was mentioned that withholding medication from the patient is illegal.